EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017


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Racetrack evaluation (Fig 2) and management/support


follows similar guidelines to the forelimbs. However, as a general principle bandages in the hindlimb should have less bulk. Heavy bandages are not well tolerated. Additionally, if medial and lateral splints are applied these will have a tendency to rotate away from the line of the third metatarsal bone over a bulky bandage. When splints are employed these should fit in apposition to the hoof wall at the bearing surface. Sufficient bandaging is then applied to fill in the dead space between the limb and splint to maintain the splints in parallel alignment to the proximal metatarsus. When a propagating (spiral) fracture is present or


suspected, splints should extend to the level of the talocentral-calcaneoquartal (proximal intertarsal) joint. Bandages should not be placed further proximad. This almost


invariably is resented strongly by horses that, in attempting to flex the limb, will abduct it in a wide proximal arc sufficient to lose balance and fall. Some horses will do this even with immobilisation as described. Attendants should be prewarned and firm but considerate handling is necessary for the safety of horse and personnel. The author’s preference for temporary immobilisation of unstable or propagating fractures is a bandage cast fitted in the described limb position and again of reduced bulk compared with the forelimb.


Transverse and oblique fractures of the diaphysis of the third metatarsal bone These are rare training and racing injuries but can follow traumatic incidents. The majority of fractures in mature horses are not amenable to repair and therefore destruction on humane grounds is indicated. When applying temporary immobilisation to those fractures that merit further consideration, the calcaneus can be used as a functional extension of the metatarsus (Bramlage 1996). A plantar splint can be placed from the calcaneus to the ground surface supplemented by a lateral splint from the level of the base of the calcaneus (adjacent to the calcaneoquartal articulation) to the bearing surface (Fig 17). These should be placed over a minimal modified Robert Jones bandage sufficient to maximise splint contact only. If the bandage is too thick, then the rigid support offered by the splints will be diminished. It also will be difficult to maintain splint-limb alignment. A cast can also be used. Like the splints, on the plantar aspect, this should extend to the calcaneus tapering dorsally to the level of the centrodistal joint. The tarsocrural joint must not be enclosed.


Fractures of the tarsus and tibia Complete fractures of the tibia are rare training and racing injuries. Most are thought to result from pre-existing stress fractures (Hill 2003a). Fractures of the tibia and fractures of the tarsus that jeopardise axial stability are particularly difficult to immobilise because of the reciprocal apparatus linking tarsal and stifle joint motion. Its action is such that if the osseous column is disrupted then the intervening fracture may become the focus of its action producing or exacerbating displacement, fracture overriding and limb collapse. Additionally, the principal muscle masses are situated laterally so that, as described with fractures of the radius, when acting over a discontinuity in the skeleton, these produce distal limb abduction (Bramlage 1996; Furst 2006; Mudge and Bramlage 2007). Such fractures thus have a propensity to become open medially. This is counteracted, as in the forelimb, by utilising a


Fig 17: Diagrammatic representation of splint positions for immobilisation of transverse and oblique diaphyseal fractures of the third metatarsal bone.


long lateral splint that should reach the level of the coxofemoral joint. Flexion and extension of the stifle cannot be prevented and the normal flexion angles of stifle and hock joints prevent use of cranial or caudal splints. However, a single wide lateral splint bent to follow limb angulation can neutralise rotational forces (Bramlage 1983; 1996; Mudge and Bramlage 2007).


The splint is placed alongside the biceps femoris with the


limb as close as possible to perpendicular to the ground. Sufficient bandage material then is placed on the distal limb to contact the splinting device. This should not be excessive or the splint’s action will be compromised and the bandage bulk will act as a pendulum on the fracture. The ideal splint material is lightweight metal such as


aluminium, electrical conduit or small diameter steel reinforcement bars (Bramlage 1983). A mild steel rod (12 mm diameter) can be fashioned into shape by hand and is strong enough to provide support (Walmsley 1996). Horses with fractures in this location will not consistently load the limb and so this is fitted with the leg semi flexed i.e. toe foot ground contact and alignment with the third metatarsal bone and phalanges. The splint extends in a straight line from the ground to the tarsocrural joint where it is bent cranially to follow the tibial diaphysis. At the stifle it is bent caudally and lies on the surface of the biceps femoris to the level of the coxofemoral joint. The splint is most effective if it is bent back on itself, retracing its course to the bearing surface (Bramlage 1983, 1996). In some smaller animals, fractures of the tarsus and tibia


can be immobilised temporarily for transport and evaluation by a laterally positioned board splint. This should be approximately 10–15 cm wide and 15 mm thick and cut to a length extending from the ground to the level of the animal’s coxofemoral joint. The limb is enclosed in bandage material sufficient to create contact with the board, which should lie on the lateral aspect of the biceps femoris and be


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